Healthcare Provider Details

I. General information

NPI: 1689068462
Provider Name (Legal Business Name): GROUP HEALTH PLAN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 GREENHAVEN RD
ANOKA MN
55303-5566
US

IV. Provider business mailing address

8170 33RD AVE SOUTH MAILSTOP 21110Q
MINNEAPOLIS MN
55440-1309
US

V. Phone/Fax

Practice location:
  • Phone: 763-587-4488
  • Fax: 763-587-4489
Mailing address:
  • Phone: 952-883-7469
  • Fax: 952-883-5395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA L BJORKMAN
Title or Position: DIRECTOR
Credential:
Phone: 952-883-7469